Welin et al, 1992

Drawing upon research demonstrating a positive association between social environment, illness and mortality, this team was among the first to include cultural participation in its consideration of activities. This study took as its sample population men born in 1913 who had been randomly selected from the Gothenburg population register in 1963. In 1973–4, all those still living locally were invited to participate in a health examination and questionnaire, along with any other men born in 1913 who had moved to the area in the intervening years and another random sample of men born in 1923. Serum cholesterol and blood pressure were measured, and data were gathered about smoking, alcohol consumption and previous incidence of heart attack and stroke. At the same time, questions were asked about self-rated health and the frequency of leisure activities undertaken inside and outside the home. Fourteen activities outside the home were assayed, including attendance at the cinema, theatre, concerts, museums and exhibitions.

A preliminary analysis of the data – with participants followed up for survival to the end of 1982 and less detail about cultural participation – was written up in The Lancet in 1985. The present study covers a re-examination undertaken in 1980, with participants followed up for mortality to the end of 1985 and causes of death classified as cancer, cardiovascular or other. Each of these three mortality causes was compared to the surviving group, and a logistic regression technique was used in a multivariate analysis involving only those variables significantly related to the specific causes of death.

When leisure-time activity patterns were considered in relation to causes of death, socially orientated activities were found to be a significant predictor of death from cardiovascular disease, but much weaker than blood pressure, smoking and previous cardiovascular illness; socio-cultural activities were found to have no impact upon cancer-related mortality, for which age and smoking habits were predictors; in relation to other causes of death, low levels of domestic activity were seen to be a predictor along with poor perceived health. Residual confounders, such as low income (common among men who declined to participate in the study), were acknowledged as significant. In summary, it was possible to say that ‘A poor social network and low levels of activities appear to be important predictors of various causes of mortality, but those already ill at the baseline examination (higher scores for perceived health or previous myocardial infarction or stroke) might be more isolated and less active due to the illness and the illness makes them more prone to death’ (p. 130). This acknowledged the possibility of a ‘disease drift’ causing diminished participation in social and cultural activities as a result of actual and perceived ill health, thus skewing the results through reverse causation. In the context of this systematic review, it is significant that cultural activities were included, but noteworthy that no distinction was made between cultural and other leisure activities occurring outside the house.